How would you describe the pain? (choose all that may apply)
Explain your pain in detail
Where do you feel pain? (indicate on body map;
add details below)
How long have you been experiencing pain? (choose one)
What is your average level of pain? (choose one)
On a scale from 1 to 10, with 1 representing minimal and 10 representing most severe, rate your personal pain.
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1 2 3 4 5 6 7 8 9 10
Welcome to relief. This discussion guide will help you prepare to get the most out of your doctor visit
by quickly and easily describing your pain, as well as suggesting questions you may want to ask.
Complete this guide before your doctor visit and bring it with you. Be ready to take notes.
And consider having a family member or friend join you to help capture all the information you need.
Doctor Discussion Guide
RightRight Left Left
FRONT BACK
Aching
Burning
Electric shocks
Freezing
Less than 6 months
1 year to 2 years
6 months to 1 year
More than 2 years
Numbness
Pins and needles
Prickly
Radiating
Sharp
Shooting
Stabbing
Tender
Notes:
Throbbing
Tingling
Weakness
Other (describe)
What type of treatment options are available for my condition?
Would a non-opioid treatment such as spinal cord stimulation (SCS), Vertiflex™ Procedure
,
or radiofrequency ablation (RFA) be eective for my pain?
Will the treatment work if I have pain in more than one area?
What restrictions will I have with this type of treatment?
What activities can I do after the treatment? Are there activities I should avoid?
How long can I expect this treatment to provide relief?
If my pain changes over time, can the treatment be adjusted?
Will I be able to stop taking pain medications?
What can I expect when receiving the treatment?
What are the risks associated with receiving the treatment?
What are some side eects I might experience?
• Does my insurance cover this treatment?
Superion™ Indirect Decompression System.
Indications for use: The Superion™ Indirect Decompression System (IDS) is indicated to treat skeletally mature patients suering from pain, numbness, and/or cramping in the legs (neurogenic intermittent
claudication) secondary to a diagnosis of moderate degenerative lumbar spinal stenosis, with or without Grade 1 spondylolisthesis, having radiographic evidence of thickened ligamentum flavum, narrowed
lateral recess, and/or central canal or foraminal narrowing. The Superion™ Interspinous Spacer is indicated for those patients with impaired physical function who experience relief in flexion from symptoms of
leg/buttock/ groin pain, with or without back pain, who have undergone at least 6 months of non-operative treatment. The Superion™ Interspinous Spacer may be implanted at one or two adjacent lumbar
levels in patients in whom treatment is indicated at no more than two levels, from L1 to L5.
Contraindications, warnings, precautions, side eects. The Superion™ Indirect Decompression System (IDS) is contraindicated for patients who: have spinal anatomy that prevent implantation of the device
or cause the device to be unstable in situ (i.e., degenerative spondylolisthesis greater than grade 1), Cauda equina syndrome, or prior decompression or fusion at the index level, scoliosis or spinous process
fractures, osteoporosis, infection, allergy or reaction to any metal or implant or a high Body Mass Index. Avoid strenuous activity for 6 weeks after surgery, contact your physician if there is fluid leaking from
your incision, if you have pain, swelling or numbness in your legs or buttocks or if you fall. Refer to the Instructions for Use provided on www.vertiflex.com for additional Indications for Use, contraindications
information and potential adverse eects, warnings, and precautions prior to using this product. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.
© 2020 Boston Scientific Corporation or its aliates. All rights reserved. NM-813212-AA
What have you already tried to help manage your pain? (choose all that may apply)
Adjusting activity/rest
Ice or heat pads
Exercise/physical therapy
Adjusting diet
Acupuncture, massage, or spinal adjustment
Interventional procedures
Over-the-counter medications such as
anti-inflammatory drugs (eg, ibuprofen)
Transcutaneous electrical nerve stimulation (TENS)
Prescription medications such as muscle relaxants,
antiseizure drugs, and some antidepressants
Prescription opioids
Nerve blocks
Surgery
Other (explain):
Here are some questions you may want to ask
your doctor or pain management specialist.
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Notes: